Irregular Astigmatism Management Using SPOT Scleral Lenses in the Treatment of Corneal Ectasia and Penetrating Keratoplasty

Abstract

To evaluate the outcome of SPOT scleral lenses in the management of irregular astigmatism in patients with corneal ectasia and penetrating keratoplasty. Second, we analyzed patients' characteristics and tolerance, comfort, and geometries of fitted lenses. Method: Over a 5-year period, we included patients experiencing irregular astigmatism fitted with SPOT scleral contact lenses, from the University Hospital of Clermont-Ferrand, France. Data collected included corneal diseases, refractive error, best-corrected visual acuity (VA) with SPOT lenses, geometry of the lens, number of adjustment consultations, and the duration of follow-up. Comfort, quality of vision, less handling, and satisfaction were evaluated using visual analog scales after a 6-month follow-up period. Results: Sixty-five patients were included, analyzing 107 eyes. Eighty percent of patients still daily wore lenses after a follow-up of 22.3613.8 months. Visual acuity improved by 0.4760.51 logarithm of the minimum angle of resolution (average increase of 5 lines) (P,0.001) after wearing scleral lenses. Comfort, quality of vision, less handling, and satisfaction of contact lenses were excellent (.75/100). Contact lenses were daily worn 10.064.1 hr/day. Most patients wore size M (17 mm) lenses (53.3% of patients), with an average sagittal height of 5.261.2 mm. Internal toricity was used in 30% of cases. Best geometry was found after 2.6960.87 consultations. Conclusion: SPOT scleral contact lenses are an effective and well tolerated method to improve the VA of patients with irregular astigmatism.

Evidence of Contact Lenses for Vision Rehabilitation in Corneal Diseases: A Review

“…16 In fact, they were considered the gold standard for patients with advanced KC, 16–18 but numerous studies reported the benefits of SL versus RGPCL for advanced corneal irregularities, achieving greater comfort, centration, stability, and providing good VA and long-term safety and efficacy. 19–25 The latter is discussed by Fuller et al showing an excellent long-term safety and efficacy of SL in the visual rehabilitation in subjects with KC, therefore achieving an improvement in VA. 21 Cagliari et al 22 also evaluated safety and highlighted that the daily use of SL in KC patients was not associated with adverse effects on the cornea or endothelium over a 90-day period and they did not find a progression of the disease. Vincent et al 25 stated that SL may provide exceptional VA outcomes in patients with complex corneal shapes that otherwise would not be achieved with a smaller diameter rigid lens.…”

“…37 Navel et al reported similar outcomes. 24 Although not included in the results of this review, there are also some case reports, such as the one published by Kumar et al that support this position. 37…”

“…Moreover, in cases where PK or DALK are necessary, SL may be a good option to correct the residual astigmatism that can appear after surgery. According to the outcomes, 40% to 50% of patients may require CL adaptation as an option after surgical intervention to improve VA. 16,24,28,39…”

“…37 Navel et al reported similar outcomes. 24 Although not included in the results of this review, there are also some case reports, such as the one published by Kumar et al that support this position. 37 It should be noted that in their study, Woodward et al describe 20% of failure rate with RGPCL in patients with postoperative ectasia, such as discomfort and intolerance to lens wear, inability to fit the shape of the ectatic cornea properly, or poor visual acuity with lenses.…”

Prescription Habits of Scleral Lenses for the Management of Corneal Irregularity and Ocular Surface Disease Among Scleral Lens Practitioners

“…Scleral lenses (SLs) are currently prescribed primarily for management of corneal irregularity and ocular surface disease. They have been shown to improve visual acuity for patients with corneal ectasias because of keratoconus, 1–5 pellucid marginal degeneration 6 and keratoglobus 7 and patients with a history of previous ocular surgery 8–13 or trauma. 14,15 In addition, SLs have been shown to improve patient comfort and maintain ocular surface integrity in patients with moderate-to-severe ocular surface disease, 16–18 chronic graft-versus-host disease, 19–21 and Stevens Johnson syndrome.…”